People in their 30s and 40s — even some in their 20s — are turning to cosmetic surgeries and procedures at an earlier age.

by Lynne Thompson

Even as she faced reconstructive surgery after a bilateral mastectomy, Joanne Marciano was fretting about the appearance of her eyes. The then-36-year-old Concord resident had long bemoaned a distinctive hereditary trait: Her eyebrows involuntarily arched in a questioning manner when she spoke. The years of repeated lifting and lowering had stretched the skin on the eyelids and under the brows, making her look tired and sad.

It wasn’t that Marciano was vain. In fact, the former registered nurse turned heart valve sales representative had opted for a mastectomy over radiation or chemotherapy so she could remain side effect free for her three children, the youngest of whom was diagnosed with leukemia the same day she learned she had cancer in one breast.

“I couldn’t take the chance that someday there would be cancer in the other side,” she reasoned.

She had thought about having her eyes done as a 45th birthday present to herself. But her diagnosis made her realize that tomorrow is never guaranteed. So she asked Dr. Gregory Fedele, of The Center for Plastic & Cosmetic Surgery in Beachwood, if he would remove the offending folds of skin while she was on the table for breast-implant surgery.

That why-wait attitude — particularly when it comes to hereditary features such as an unattractive nose — is just one of the reasons plastic surgeons are seeing more people requesting procedures at a much younger age.

Dr. Lu-Jean Feng of the Lu-Jean Feng Clinic in Pepper Pike notes that news reports and television shows such asExtreme Makeover andDr. 90210 have democratized plastic surgery — once “a procedure for the privileged” — and made people more open to and aware of the various cosmetic options available.

Many people used to think that their only option was a face-lift, says Dr. Steven Goldman of Beachwood Plastic Surgery and Medical Spa. “Now you’ve got a lot more doctors out there who are ready to take care of people at a younger age.”

Indeed, Fedele, Feng and Goldman all say that more clients are scheduling noninvasive procedures or minor surgeries to maintain their appearance rather than undergo an attention-getting overhaul at a later date. “They’d rather have people wonder what they had done,” Fedele says.

Some even see plastic surgery as a prudent career move. Maturity, experience, enthusiasm and a youthful appearance, as Feng points out, are hot commodities on the job market.

But the biggest physical perk to having plastic surgery at a younger age is a shorter recovery time and better results.

“At a younger age, your skin is more elastic, has more collagen and will respond to surgery better,” Fedele explains. “When you’re doing a lift or removing skin, it will certainly stand up to it better than that of somebody two or three decades older. It’s kind of like a waistband that has lost its elasticity. It stretches out and won’t snap back as well.”

That resiliency is particularly important in recovering from breast reductions and liposuction, a procedure in which a blunt, rod-shaped surgical instrument called a cannula is inserted through an incision into the subcutaneous fat layer and used to suction out the fat. Feng says her patients are requesting the procedures as early as their teens and 20s.

While breast augmentation remains popular, Feng sees plenty of women who want to reduce their size. The downside of having a large bust includes back and shoulder pain, and difficulty exercising and participating in sports. “There are women who want attention on their face, not on their breasts,” she observes. “They really feel big breasts are an impediment.” She credits the increase in liposuction and tummy tucks to America’s obesity epidemic.

“There are more people who are fatter at age 25 than 20 years ago,” she says. “And people want to see improvements sooner.”

By the time people are in their 30s and 40s, they are turning to “injectables” and other nonsurgical procedures such as Fraxel and Thermage (see page 114) to turn back the clock.

The most popular injectable is Botox, a refined protein produced by the same bacteria that causes botulism. It softens or eradicates a wrinkle — forehead lines, crow’s feet, smoker’s lines around the lips — by temporarily paralyzing the muscles that caused it.

Coming up a close second are “fillers” such as Juvederm and Restylane, which are used to enhance lips and fill nasolabial folds (the grooves that develop from the corners of the nose to the corners of the mouth) and depressions in front of the jowls. Although immediate results last a matter of months, Feng says studies suggest some people may achieve permanent improvement with repeated injections over an extended period of time. But there is a point when injectables are not enough.

“Once you have too much skin and too much of a shift in your soft tissues, you really need surgery to correct it,” Feng says.

The first and most noticeable thing to go is usually the eyes — or, more specifically, the areas around them. According to Goldman, patients in their late 30s and 40s begin to complain of puffiness, under-eye hollows and wrinkling.

“We’re constantly smiling, squinting, doing things that will produce fine lines and wrinkles,” Fedele says. “Tissues holding the fat back around the eyes tend to loosen and become more prominent.”

Like Marciano, people often contemplate an upper and/or lower eyelid lift, technically known as a blepharoplasty. The former involves removing excess skin and fat through an incision in the eyelid crease; the latter entails removing or repositioning fat through an incision just under the lower-lash line. The lifts are often accompanied by a brow lift, in which a surgical device called an endoscope is used to reposition drooping brows through a series of small incisions made just inside the hairline.

“They sort of go hand in hand,” Fedele says of the procedures, “because the position of the eyebrow sometimes dictates the appearance of the eyes.”

By the mid- to late 40s, Fedele says people are considering a lower or modified face-lift to eradicate jowls and tighten skin around the neck. The incisions, which follow the contours of the ear, are similar to those made in a traditional face-lift. But the work done during the procedure is less extensive, which means there is less bruising, swelling and, in turn, less downtime.

Many of these procedures have allowed patients to put off the traditional face-lift until later in life. And, as Marciano attests, getting the most out of life.

“It was probably the greatest thing I ever did,” she raves. “I feel like a new woman.”